edoc

Retention in care and virological failure among adult HIV+ patients on second-line ART in Rwanda: a national representative study

Nsanzimana, Sabin and Semakula, Muhammed and Ndahindwa, Vedaste and Remera, Eric and Sebuhoro, Dieudonne and Uwizihiwe, Jean Paul and Ford, Nathan and Tanner, Marcel and Kanters, Steve and Mills, Edward J. and Bucher, Heiner C.. (2019) Retention in care and virological failure among adult HIV+ patients on second-line ART in Rwanda: a national representative study. BMC infectious diseases, 19 (1). p. 312.

[img] PDF - Published Version
Available under License CC BY (Attribution).

595Kb

Official URL: https://edoc.unibas.ch/70149/

Downloads: Statistics Overview

Abstract

Currently, there is limited evidence on the effectiveness of second-line antiretroviral therapy (ART) in sub-Saharan Africa. To address this challenge, outcomes of second-line protease inhibitor (PI) based ART in Rwanda were assessed.; A two-stage cluster sampling design was undertaken. 49 of 340 health facilities linked to the open-source electronic medical record (EMR) system of Rwanda were randomly sampled. Data sampling criteria included adult HIV positive patients with documented change from first to second-line ART regimen. Retention in care and treatment failure (viral load above 1000 copies/mL) were evaluated using multivariable Cox proportional hazards and logistic regression models.; A total of 1688 patients (60% females) initiated second-line ART PI-based regimen by 31st December 2016 with a median follow-up time of 26 months (IQR 24-36). Overall, 92.5% of patients were retained in care; 83% achieved VL ≤ 1000 copies/ml, 2.8% were lost to care and 2.2% died. Defaulting from care was associated with more recent initiation of ART- PI based regimen, CD4 cell count ≤500 cells/mm; 3; at initiation of second line ART and viral load > 1000 copies/ml at last measurement. Viral failure was associated with younger age, WHO stage III&IV at ART initiation, CD4 cell count ≤500 cells/mm; 3; at switch, atazanavir based second-line ART and receiving care at a health center compared to hospital settings.; A high proportion of patients on second-line ART are doing relatively well in Rwanda and retained in care with low viral failure rates. However, enhanced understandings of adherence and adherence interventions for less healthy individuals are required. Routine viral load measurement and tracing of loss to follow-up is fundamental in resource limited settings, especially among less healthy patients.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Malaria Vaccines (Tanner)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Health Interventions > Malaria Vaccines (Tanner)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Nsanzimana, Sabin and Tanner, Marcel
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:BMC
ISSN:1471-2334
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:10 Apr 2019 06:56
Deposited On:10 Apr 2019 06:56

Repository Staff Only: item control page